Development & preliminary findings. Mark Deady; Maree Teesson, PhD; Frances Kay-Lambkin, PhD; Katherine Mills, PhD

Transcription

1 Development & preliminary findings Mark Deady; Maree Teesson, PhD; Frances Kay-Lambkin, PhD; Katherine Mills, PhD

2 Main causes of DALYs for year-olds Cause Total DALYs (x1000) (%) Unipolar depressive disorders 193 (8.2) Road traffic accidents 127 (5.4) Schizophrenia 96 (4.1) Bipolar disorder 88 (3.8) Violence 81 (3.5) Alcohol use 71 (3.0) (Gore, et al., 2011)

3 Among those with lifetime major depression years Overall 37% 34% meet criteria for an alcohol use disorder Among those lifetime with alcohol use disorders years Overall 18% 23% meet criteria for depression (National Survey of Mental Health and Wellbeing, 2008)

4 Comorbidity compounds problems of either condition in isolation Associated with increased rates of: Suicidality (Sher, 2006; Sher, et al., 2009) Hospitalisation and ED visits (Pettinati, 2004; Curran, et al. 2008) Additional comorbidities (Davis et al. 2008) Substance misuse (Erfan, et al. 2006) Early relapse (Dodge, et al. 2005) and poorer: Functioning (Sullivan, et al, 2005; Davis, et al. 2008) Treatment outcomes (Tomlinson, et al. 2004)...compared to those without such comorbidity.

5 In order to: Arrest problems early Avoid career and study disruption Reduce long-term health consequences Develop healthy coping skills... However...

6 Although one in four Australians between the ages of 16 and 24 experienced a mental disorder in the last 12-months......less than 25% of these affected young people accessed health services in a 12-month period. (Reavley, et al., 2010)

7 Why do young people not seek treatment? Individual determinants Mental health literacy Attitudes to services Attitudes to conditions Perceived stigma Time commitments Reliance on self Structural determinants Support systems Referral pathways Payment systems Geographical isolation Lack of relevant services (Barker, et al., 2005; Rickwood, et al., 2007)

8

9 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% year olds Go online Use search engine Look for health info Social networking Watch a video After family and friends, the Internet is the preferred source of advice and support for young people (Mission Australia, 2010) (Pew Internet Project, 2010)

10 Advantages of online treatment: Anonymity Reach Cost Empowerment Flexibility (Burns, et al., 2009; Nicholas et al., 2004)

11 Individual determinants Mental health literacy Attitudes to services Attitudes to conditions Perceived stigma Time commitments Reliance on self Structural determinants Support systems Referral pathways Payment systems Geographical isolation Lack of relevant services (Barker, et al., 2005; Rickwood, et al., 2007)

12 Individual determinants Mental health literacy Attitudes to services Attitudes to conditions Perceived stigma Time commitments Reliance on self Structural determinants Support systems Referral pathways Payment systems Geographical isolation Lack of relevant services (Barker, et al., 2005; Rickwood, et al., 2007)

13 Meta-analyses for depression: d = 0.41 (Andersson & Cuijpers, 2009) d = 0.32 (Barak, et al. 2008) d = 0.32 (Spek et al 2007) d = 0.28 (Cuijpers, et al., 2011) d = 0.42 to 0.65 (Griffiths, et al., 2010) Meta-analyses for alcohol: d = 0.48 (Barak, et al. 2008) g = 0.39 (Riper, 2011) d = 0.42 (White, et al., 2010) d = 0.22 (Riper, at al 2009) d = 0.26 (Rooke, et al. 2010) g = 0.78 (Andrews, et al., 2010) Equivalent to standard to traditional, face-to-face therapies (Barak, et al., 2008; Cuijpers, et al., 2008)

14 Disorders exacerbate + maintain one another (Falk, et al., 2009; King et al., 1996) Success of integrated treatment (Baker, et al., 2010) The Self Help for Alcohol/other drug use and DEpression (SHADE) program for the general population First computerised therapy for this form of comorbidity 10-week, CD-ROM package CBT and Motivational Interviewing based Equivalent 12-month outcomes relative to a live intervention (Kay-Lambkin, Baker, Kelly, & Lewin, 2011; Kay-Lambkin, Baker, Lewin, & Carr, 2009)

15

16 Brief (4-week) intervention for depression and alcohol use problems Developed from SHADE, best practice guidelines, and focus testing Non-confrontational approach regarding alcohol use Motivational enhancement principles CBT components Solution-focussed and skills-based Interactive Follow the story of a selected case study Personalised normative feedback User interaction and control (flexible in timing + content)

17 Week 1 WHERE ARE YOU AT? Psycho-education, assessment, goal setting, normative feedback, mood/activity/alcohol use monitoring Week 2 GETTING MOVING AGAIN Behavioural components, decisional balance (alcohol use), behaviour change, activity scheduling Week 3 TAKING CHARGE OF YOUR THOUGHTS Mood monitoring, cognitive restructuring Week 4 COPING WITH TOUGH SITUATIONS Coping skills: mindfulness + relaxation, problem solving, drink reduction + refusal, relapse planning + management

18

19

20

21 Aim: To evaluate whether the DEAL Project can be effective in treating co-occurring mildmoderate depression and problematic alcohol use in young adults. Methods: This evaluation took the form of a RCT comparing the DEAL Projec to an attentioncontrol condition (HealthWatch) and measuring participant outcomes across three followup points. The study was conducted Australia-wide and entirely online with minimal participant contact. All contact made occurred via .

22 Inclusion criteria: 1) Age of years 2) Current depressive symptoms (score of 7 on DASS-21 Depression) 3) Harmful drinking as measured by the AUDIT (score of 8) 4) Ability to access the Internet 5) Australian residency Exclusion criteria: 1) Psychotic symptoms screener score 3 2) Inability to speak English 3) Serious risk of suicide (serious past 2-week thoughts of suicide and desire to act) 4) Daily use of cannabis/weekly use of amphetamines.

23 Primary depression outcome measure: Patient Health Questionnaire (PHQ-9) Primary alcohol use outcome measure: TOT-AL (measures quantity and frequency of use)

24 Flow of participants through the trial Recruitment Assessed for eligibility (n = 839) Baseline assessment (N = 104) excluded (n = 621) declined (n = 144) Randomisation The DEAL Project (treatment) 4 weeks (n = 60) Post treatment assessment (5 weeks) Follow-up at 12- and 24-weeks HealthWatch (active control) 4 weeks (n = 44) Post treatment assessment (5 weeks) Follow-up at 12- and 24-weeks

25 Total sample (N = 104) % female 59.6 Mean age (SD) 21.7 (2.2) % Completed secondary school 81.7 % Tertiary education 75.0 % Unemployed 10.9

26 Total sample (N = 104) Mean PHQ-9 score (SD) 16.3 (5.0) Mean AUDIT score (SD) 17.0 (6.0) Median drinks per week (IQR) 15.2 (10.3) Median drinking days per week (IQR) 2.0 (3.0) Median max consumption (IQR) 11.4 (6)

27 Total sample (N = 104) % GP 58.7 % Psychiatrist 43.3 % Psychologist 31.7 % Medication 29.8 % Other mental health worker 14.4 % Alcohol/drug worker 5.8

28 Frequency Modules completed

29 PHQ-9 score p <.001 p = Baseline Post-treatment Timepoint DEAL Project Control Analysis: Generalised estimating equations

30 40 Drinks per week p < p = Baseline Post-treatment Timepoint DEAL Project Control Analysis: Generalised estimating equations

31 Drinking days per week p <.001 p = Baseline Post-treatment Timepoint DEAL Project Control Analysis: Generalised estimating equations

32 Preliminary findings: The DEAL Project was associated with significant reductions in both: Depression symptoms Alcohol use frequency and quantity.compared to an attention-control condition in the short-term. Limitations: Post-treatment only: 3- and 6-month follow-ups to come Retention and attrition: 33 participants completed no sessions (31 of which did not complete follow-up) Overall loss to follow-up = 46.2%

33 My supervisors: Prof. Maree Teesson Dr. Frances Kay-Lambkin Assoc. Prof Kath Mills The National Drug and Alcohol Research Centre at the University of NSW is supported by funding from the Australian Government

34 Facebook: facebook.com/thedealproject Twitter: